Help *not life threatening*! Lucy's first very low numbers. Do I give insulin??

[hellolucy]

I just took Lucy's PM pre-shot - her first test came back at 98. I thought it was for sure an error and her second test came back at 126! She's just recently (within the past week or two) started dipping into the 200's with some very scattered 100s, but never below 100. She is on some pretty high doses of insulin - 11U 2x per day so am worried about giving her insulin. Do I give her a shot or skip this one?

 

[MyTitan (GA)]

HI there, quick look at Lucy's SS, she hasn't officially earned a reduction yet , if you can monitor I'd say yes shoot but keep a close eye on her. The depot is coming into effect. Is she IAA positive? Titan had same issues

 

[MyTitan (GA)]

It is scary and rewarding seeing the first greens.

 

[hellolucy]

HI there, quick look at Lucy's SS, she hasn't officially earned a reduction yet , if you can monitor I'd say yes shoot but keep a close eye on her. The depot is coming into effect. Is she IAA positive? Titan had same issues

I can monitor for the next ~3 hours or so but then have to head to bed for work tomorrow. The in between/sleeping hours are the part I'm worried about with her being given 11U on such a low number. So, in that case, not sure if I should or not? I recently had another post asking for opinions on her high insulin numbers and someone recommended getting her tested for IAA and acromegaly. She has a vet appointment this Saturday to get the blood drawn! So we'll find out.

 

[MyTitan (GA)]

You can always give the BCS we call it the big chicken shot, reduce the insulin by half or a quarter. That should allow you to sleep but will throw Lucy off the next couple of cycles and you have to take that into account. On that dose I would guess she is pos for acromegaly and IAA is a mystery.

 

[MyTitan (GA)]

We didn't get Titan tested for IAA a mistake on our part. Just considered him positive and hoped for a break through. It came at 12 units and he is now down to 7 units twice a day but there are a few PJ party's in there as we were coming back down

 

[hellolucy]

You can always give the BCS we call it the big chicken shot, reduce the insulin by half or a quarter.

I am still struggling with what to do (whether to just skip or reduce to 10.5). I am just so nervous about going to sleep giving her insulin with that number. Though I know the sticky says don't shoot less than 50, and we're pretty far off from that.

It came at 12 units and he is now down to 7 units twice a day but there are a few PJ party's

His spreadsheet looks great! It really does look very similar to Lucy's

 

[MyTitan (GA)]

I'm tagging @Wendy&Neko , she has been helping us get Titan regulated and us a resident expert. Hopefully she will chime in soon plus thus will bump you back up.

 

[hellolucy]

So I just gave her 10.5U (tested before - 1 hour since she's eaten and previous test - and her number came back at 160, so a lot more comfortable)...we'll see how the night plays out!

 

[Chris & China (GA)]

I am still struggling with what to do (whether to just skip or reduce to 10.5).

Have you fed her yet?

If not, test again

 

[hellolucy]

Have you fed her yet?

If not, test again

Yes, I fed her and took her pre-shot number at the same time.

 

[Chris & China (GA)]

So I just gave her 10.5U...we'll see how the night plays out.

OK....what's done is done......hopefully she'll have a nice safe surf, but in the future, if you have a Pre-shot number you're not sure about, stall, don't feed and test again in about 20-30 minutes.

If they head up, then it's probably going to be OK to shoot the scheduled dose because the old one is wearing off.

However, if you're shooting a BCS, there's no guarantee that she won't drop low on that cycle. The depot is still in play and pumping out the 11U dose, so usually, if you're going to do a BCS, make it a larger reduction than .5 (at that dose anyway)

I'd plan on getting a +1 and +2 ......and let's see where she is ....You may have to set an alarm and get naps in when you can.....but she may also do great.....or she may start a huge bounce because greens are pretty unusual for her

 

[Marje and Gracie]

With a depot that large and a dropping number, 10.5u is like shooting 11u (BTW, the SS has that you shot 11u).

You might be up for a long night. Please be sure you have plenty of strips, HC food, karo or honey. You might have to be up longer than three hours.

I strongly suggest you feed her a good meal and get a +1 to start and then a +2.

 

[hellolucy]

OK....what's done is done......hopefully she'll have a nice safe surf, but in the future, if you have a Pre-shot number you're not sure about, stall, don't feed and test again in about 20-30 minutes.

If they head up, then it's probably going to be OK to shoot the scheduled dose because the old one is wearing off.

However, if you're shooting a BCS, there's no guarantee that she won't drop low on that cycle. The depot is still in play and pumping out the 11U dose, so usually, if you're going to do a BCS, make it a larger reduction than .5 (at that dose anyway)

I'd plan on getting a +1 and +2 ......and let's see where she is ....You may have to set an alarm and get naps in when you can.....but she may also do great.....or she may start a huge bounce because greens are pretty unusual for her

Thank you! This is good to know as hopefully she'll be getting more green numbers in the future. I'm entering in to a whole new ballgame now with these low numbers and have a lot more to learn! What dose of insulin would you have given in this situation?

(BTW, the SS has that you shot 11u)

Whoops, just updated to 10.5 and added in a comment that her shot was given late due to the low number. I do have honey on hand. I will probably be waking up a bunch (if I can even sleep), no doubt, and will definitely be keeping an eye on her and updating the spreadsheet as soon as I grab any new numbers.

 

[Chris & China (GA)]

What dose of insulin would you have given in this situation?

With a depot that large, if you decide to do a BCS, you're probably looking at something in the 1/2 to 2/3rd range.....so 5.5 to about 8

But even doing that much of a reduction doesn't necessarily mean she won't drop low on that cycle....there's still a lot of insulin in the depot

It really is a balancing act...we WANT to see those great numbers, and shooting low is definitely better than shooting high (Lantus works best that way) but it can mean losing a lot of sleep too

 

[hellolucy]

With a depot that large,

So I understand the general idea behind the depot due to the stickys I've read, but am curious as to how it is being determined with Lucy. Is the depot with her large because she is on such high units and has been for the past several cycles? Just trying to better understand.

if you have a Pre-shot number you're not sure about, stall, don't feed and test again in about 20-30 minutes.

Usually, I'll put Lucy's food down then immediately start testing her ear. This is really the only way I'm able to get a shot from her around food time as she's distracted. So moving forward, I'll have to make sure the two are very closely timed together and immediately pick her food up if I'm unsure of the number. You mentioned that if I stall, test again in about 20 - 30 minutes, and then the numbers are going back up, it is likely okay to shoot. Is this the same in her case because the units she's receiving are so high? And in terms of going up, does the BG number need to be a large increase to be considered okay or just any increase to represent an upward pattern?

 

[Chris & China (GA)]

Is the depot with her large because she is on such high units and has been for the past several cycles?

Yes....a cat on 1U is going to burn through their depot a lot faster than a cat on 10U

This is really the only way I'm able to get a shot from her around food time as she's distracted.

You might try giving her just a tiny snack of something like baked chicken ....just something to help distract her while you get the test in but it won't cause her blood glucose to go high due to a lot of carbs

Is this the same in her case because the units she's receiving are so high?

No, we suggest stalling to anyone who's shooting a lower number than they're used to shooting. Once you get more experience, it's not as important to stall first. I'll shoot anything over 50, but I have a lot of data on how China responds to both insulin and food, and I know how she usually acts when she's dropping too low or too quickly. Know Thy Cat!!

And in terms of going up, does the BG number need to be a large increase to be considered okay or just any increase to represent an upward pattern?

It should be enough that you're comfortable that they're really going up....that the last shot is wearing off.

During the 20-30 minute stall, post for help and someone will not only be able to advise you when it's safe, but they'll also be able to tell you if they are going to be able to stay online and watch for you. We have an unwritten "rule" here....if someone is shooting a low number for the first time, whoever replies to help will stay with them as long as necessary to make sure they stay safe until everyone is sure they are going to be OK. If they can't, they should say so up front. Make sure your subject line says something like "STALLING...NEED HELP!" so those people scanning the forum will know you're waiting for advice.

If they have to leave later on, they will find someone else with experience to take over. Of course it's always a good idea to have the "How to deal with hypo's" printed out and kept somewhere you won't lose it. The message board has been known to go down at the worst times!!

 

[Chris & China (GA)]

Looks like she's going to bounce!!

At least you can get some sleep!!!!

 

[Wendy&Neko]

Here's the link to your last post here. We include those links so people can easily go back and see the history.

Good to see the numbers are starting to move on 11 units. I would go back to 11 units tomorrow morning, and hold the dose at least 8 cycles to see if she can get back to that lovely green again. I notice a few nights this last week with no tests after PMPS. Now that you are starting to see some good numbers, it's a really good practice to get at least a before bed test in every night, so you can catch if she's heading low at night. Many cats go lower at night.

First few times I shot low blues, then first greens, Neko bounced right away.

 

[hellolucy]

Looks like she's going to bounce!!

At least you can get some sleep!!!!

Just took another one and she's at 311 now, so it's off to bed with an alarm set in a few hours just to get up and make sure she's doing okay. Thank you very much for your help!!